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General NPI Number Information
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NPI Number | 1962011890
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Entity Type | Organization
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Legal Business Name | GREEN STAR PHARMACY
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 2950 WINKLER AVE STE 701
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City | FORT MYERS
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State | FL
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Zip | 33916-9322
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Country | US
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Telephone | 239-931-3605
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Fax | 239-931-3605
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Provider Business Mailing Address
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Address Line | 2611 30TH ST SW
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City | LEHIGH ACRES
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State | FL
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Zip | 33976-4091
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Country | US
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Telephone | 239-240-4345
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Fax | 239-931-3605
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Authorized Official
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Title or Position | PHARMACY MANAGER/ PHARMACIST
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Name | MR. FRUSNEL AUGUSTIN
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Credential | RPH
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Telephone | 123-924-0434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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